Scrotal edema is not an uncommon presentation in emergency medicine. We describe the case of a 58-year-old male with no prior medical history who presented to the emergency department (ED) due to progressive scrotal edema. The patient noted increased painless testicular enlargement, dry cough, and dyspnea on exertion over the course of several weeks. Scrotal edema was evaluated by an Ultrasound (US), showing bilateral testicular edema with concern for congestive heart failure (CHF). Computed tomography pulmonary angiography (CTPE) scan showed a large 6.51 cm thoracic aortic aneurysm (TAA), cardiomegaly with dilated left sided chambers, and a small pericardial effusion. Subsequently, the patient had a transthoracic echocardiogram (TTE) and was found to have left ventricular ejection fraction of 35% with severe aortic regurgitation, causing heart failure. Patient was transferred to the operating room (OR) for an aortic valve, aortic root, and ascending aorta replacement. Patient was deemed medically stable for discharge to home 2 weeks after initial TAA findings. TAA is a silent disease and an important cause of mortality in adults. Early recognition by astute clinicians can significantly reduce morbidity and mortality
